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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000508

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elizabeth MaryCrockett Sex Female

Date of Birth July 28, 1923 Place of Birth Middle RiverCounty of Pictou

Name of Father Levi Archibald Crockett MAIDEN NAME of Mother Mary Roynolds

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Middle River Pictou Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Middle River, Pictou Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Elizabeth Mary Crockett O'Brien Address of Applicant Downsview, Ontario Date 24 December 1974

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elizabeth MaryCrockett

Born at Middle River in the County of Pictou

That Elizabeth MaryCrockett Whose Birth is sought to be registered was

born at Middle River Pictou County on July 28, 1923

My knowledge of the fact and date of such Birth is based on the following Circumstances:

1. that I was well acquainted with the family all my life, being a close neighbour 2. That the applicant and I are very close in age, and I recall her birthday celebrations 3. That we attended the same school for several years, which was a small rural school where everyone knew each other's age and birthdate

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